Metabolic acidosis and sudden infant death syndrome: overlooked data provides insight into SIDS pathogenesis.

IF 6.1 2区 医学 Q1 PEDIATRICS
Paul N Goldwater, Dov Jordan Gebien
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Abstract

Background: Decades of mainstream SIDS research based on the Triple Risk Model and neuropathological findings have failed to provide convincing evidence for a primary CNS-based mechanism behind putative secondary dyshomeostasis (respiratory or cardiac) or impaired arousal. Newly revealed data indicate that severe metabolic acidosis (and severe hyperkalemia) is a common accompaniment in SIDS. This supports the direct effect of sepsis on vital-organ function and occurrence of secondary CNS changes accompanied by the dyshomeostasis leading to SIDS.

Data sources: Using PubMed and Google Scholar literature searches, this paper examines how metabolic acidosis and sepsis might contribute to the underlying pathophysiologic mechanisms in SIDS.

Results: The discovery of a series of non-peer-reviewed publications provided the basis for a serious examination of the role of metabolic acidosis and sepsis in SIDS. Most SIDS risk factors relate directly or indirectly to infection. This consequently elevated the position of septic or superantigenic shock and viremia in causing secondary organ failure leading to SIDS. The latter could include diaphragmatic failure, as evidenced by peripheral respiratory (muscle) arrests in experimental septic shock, as well as infectious myositis and diaphragm myopathy in sudden unexpected deaths, including SIDS. In addition, just as acidosis lowers the threshold for ventricular fibrillation and sudden cardiac arrest, it could also contribute to similarly unstable diaphragm excitation states leading to respiratory failure.

Conclusions: This paper uniquely reveals compelling evidence for a connection between metabolic acidosis, sepsis, viral infections, and sudden unexpected child deaths and provides a solid basis for further work to define which pathway (or pathways) lead to the tragedy of SIDS. It is recommended that all autopsies in sudden unexpected deaths should include pH, bicarbonate, lactate, and electrolyte measurements, as well as diaphragm histology.

代谢性酸中毒和婴儿猝死综合征:被忽视的数据提供了对SIDS发病机制的见解。
背景:几十年来基于三重风险模型和神经病理学发现的主流小岛屿发展中国家研究未能提供令人信服的证据,证明继发性动态失衡(呼吸或心脏)或觉醒受损背后的主要基于中枢神经系统的机制。新发现的数据表明,严重代谢性酸中毒(和严重高钾血症)是小岛屿发展中国家的常见伴随症状。这支持了败血症对重要器官功能的直接影响和继发性中枢神经系统改变的发生,并伴有动态失衡导致SIDS。数据来源:通过PubMed和谷歌Scholar文献检索,本文探讨了代谢性酸中毒和败血症如何影响小岛屿发展中国家潜在的病理生理机制。结果:一系列非同行评议出版物的发现为认真研究代谢性酸中毒和败血症在小岛屿发展中国家中的作用提供了基础。大多数小岛屿发展中国家的危险因素直接或间接与感染有关。因此,脓毒性休克或超抗原休克和病毒血症在继发性器官衰竭导致小岛屿发展中国家中的地位升高。后者可能包括膈肌衰竭,在实验性感染性休克中表现为外周呼吸(肌肉)停止,以及感染性肌炎和膈肌病在突发性意外死亡中,包括小岛屿发展中国家。此外,就像酸中毒降低心室颤动和心脏骤停的阈值一样,它也可能导致类似的不稳定的膈肌兴奋状态,导致呼吸衰竭。结论:本文独特地揭示了代谢性酸中毒、败血症、病毒感染和儿童意外猝死之间联系的令人信服的证据,并为进一步确定导致SIDS悲剧的途径(或途径)提供了坚实的基础。建议所有突发意外死亡的尸检应包括pH值、碳酸氢盐、乳酸盐和电解质测量,以及隔膜组织学。
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来源期刊
World Journal of Pediatrics
World Journal of Pediatrics 医学-小儿科
CiteScore
10.50
自引率
1.10%
发文量
592
审稿时长
2.5 months
期刊介绍: The World Journal of Pediatrics, a monthly publication, is dedicated to disseminating peer-reviewed original papers, reviews, and special reports focusing on clinical practice and research in pediatrics. We welcome contributions from pediatricians worldwide on new developments across all areas of pediatrics, including pediatric surgery, preventive healthcare, pharmacology, stomatology, and biomedicine. The journal also covers basic sciences and experimental work, serving as a comprehensive academic platform for the international exchange of medical findings.
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